As the United States becomes more of a melting pot, encouraging and nurturing a workplace that welcomes the different cultures, ethnicities, and lifestyles of staff are paramount to optimal collaboration, productivity, and success. In health care, where diversity increasingly is exemplified among patients as well as employees, such an embrace is critical to achieving best outcomes.
Health care institutions across the country are heeding the call for inclusion. Many have implemented initiatives to not only attract diverse staff, but also to keep and engage them.
The Mayo Clinic in Rochester, Minnesota, for instance, launched the Multicultural Nurses Mayo Employee Resource Group (MNMERG) in July 2014 to recruit and retain nurses from diverse cultures and offer them professional support and networking opportunities. The MNMERG also mentors and educates Mayo’s diverse nurses and involves them in community programs.
With some 25 members, the MNMERG welcomes all Mayo staff. It meets monthly at the hospital, but this year will add quarterly dinners off site and is evaluating online technologies such as Skype and Sharepoint to “engage a 24/7 workforce,” says MNMERG cochair Deborah A. Delgado, MS, RN-BC, a nursing education specialist in psychiatry.
Mayo Employee Resource Groups (MERGs) have been an important component of Mayo’s overall diversity initiative; the goal is to have the following five core MERGs—African American, LGBTI, Hispanic, Disability, and Veterans—at Mayo’s three major clinical sites. Each MERG has an executive sponsor who is a leader at Mayo, but not a member of the group. For example, the MNMERG’s sponsor is a male cardiologist with experience in developing family/patient advisory groups. All of Mayo’s MERGs have formally chartered to align with at least one of the organization’s strategic diversity goals.
“These range from culturally competent care to inclusion and addressing health disparities,” says Sharonne N. Hayes, MD, FACC, FAHA, director of diversity and inclusion and professor of medicine at the Women’s Heart Clinic at Mayo. She notes that the groups share innovations and hold cross activities. “By that collaboration,” she says, “you get more hands to do the work obviously, but you also get a wonderful side product of some cross-cultural mentoring and some cross-cultural experience.”
While the MNMERG is in its infancy, feedback has been positive. “By being visible, by engaging, and by contributing, it just leads to retainment,” Delgado offers. “People want to stay because they’re able to use all of their gifts and talents to affect the organization’s purpose and goals.”
The Clinical Leadership Collaborative for Diversity in Nursing (CLCDN) at Massachusetts General Hospital in Boston has realized recruitment and retention success with diverse students of nursing. A scholarship and mentoring program established in 2007 by Partners HealthCare (PHC), an integrated system of which Mass General is a member, the CLCDN draws applicants from the nursing program at University of Massachusetts Boston.
Students must demonstrate leadership qualities, have cumulative general and nursing GPAs of 3.0 or higher, and must be entering their junior year of study since the CLCDN will carry them through their senior year. They link with racially and ethnically diverse nurse mentors, attend unit meetings and social and educational events, and observe nurses and nursing leaders in action. Additionally, they receive a stipend and financial support for tuition and fees with the expectation they will pursue employment at a PHC institution after graduating.
“When you’re a minority and you’re going into an environment where you might be the only diverse person on your clinical unit, as an example, it can be really challenging; it can be very lonely,“ says Gaurdia E. Banister, PhD, RN, FAAN, the PHC CLCDN liaison to UMass Boston and executive director of the hospital’s Institute for Patient Care. “We wanted to put mechanisms in place to ensure the success of our students and, certainly once they graduated, the best possible [career] alternatives,” she says.
Mass General diverse nurse leaders who have successfully navigated such waters can “provide these wonderful, wonderful pearls of wisdom and support and encouragement and listening skills,” explains Banister, and they serve as mentors, as do CLCDN graduates. Of the 54 mentors to date (32 from Mass General), some are repeats. Other statistics are just as impressive—such as PHC’s 82.6% hiring rate among the 69 graduates thus far (47.8% of whom have been employed by Mass General) and the almost 80% retention rate for these graduates.
“They love being a nurse. It’s exactly what they anticipated their career to be,” says Banister. “They are constantly promoting how positive it has been for them and that they feel like our organizations are becoming much more of a welcoming and diverse place to work.”
At the Cleveland Clinic, location-specific Diversity Councils at each of the enterprise’s community hospitals and family health centers are effectively supporting and sustaining an inclusive work environment. These employee-led councils implement action plans and sponsor activities based on strategies and goals defined by an Executive Diversity Council, all aimed to enhance employee engagement and cultural competence.
While the Executive Diversity Council works “to set the tone and the agenda,” the location-specific councils “serve as the tactical team,” explains Diana Gueits, director of diversity and inclusion. The main-campus council, for one, formed the Nursing Cultural Competence Committee and the Disability Task Force; the task force, in turn, developed the Disability Etiquette Lunch ’n Learn, a program to assist caregivers in their interaction and communication with disabled individuals that has since been taken enterprise-wide. Gueits notes the councils share and cross-pollinate ideas.
Cleveland Clinic’s chief nursing officer sits on the Executive Diversity Council, and many nurses participate in the location-specific councils with several diverse nurses serving in leadership roles (the councils overall represent a cross-section of the clinic’s workforce). Two cochairs and a cochair-elect lead each council, act as local ambassadors for diversity, engage with executive leadership, and provide feedback to the Office of Diversity and Inclusion, which facilitates the business-like, SMART-goals approach of the councils.
“This is a passion for them,” says Gueits of the cochairs, who are selected based on their experience in leading transformative teams and their commitment to diversity and inclusion. “I think that what the councils provide them is an opportunity to see, to actually be part of an initiative and be part of that process from A to Z.”
Cleveland Clinic has 21 location-specific councils, a number that is sure to increase as the enterprise expands. “That is the intention,” Gueits says, “to make sure that we embed diversity and inclusion in our commitment to all our locations and give an opportunity or platform for all our caregivers to be engaged.”
Julie Jacobs is an award-winning writer with special interest and expertise in health care, wellness, and lifestyle. Visit her at www.wynnecommunications.com.
“The mediocre teacher tells. The good teacher explains. The superior teacher demonstrates. The great teacher inspires.”
—William Arthur Ward
The role of the academic nurse educator is both rewarding and challenging. Furthermore, the nurse educator plays a pivotal role in the nursing profession as well as in the development and preparation of future nurses and advanced degree nurses. The nursing profession is currently experiencing a faculty shortage. According to the American Association of Colleges of Nurses, the national vacancy rate for the 2014–2015 academic year is 6.9%, which limits our ability to adequately prepare our future workforce. Consequently, this is the perfect time to consider transitioning into an academic role.
Some of the factors related to the current faculty shortage include an aging workforce, lack of a diverse cadre of educators, educational requirements, the cost associated with advancing one’s education, and lack of competitive financial compensation. Although the financial compensation is not competitive with current nursing salaries, the educator role is extremely rewarding and offers a certain degree of flexibility and autonomy.
There are several paths you can choose on your journey into the world of academia. All nurses are teachers in their own right, and nurse educators build upon these foundational skills via education and experience. Seeking out opportunities, such as the role of preceptor, patient educator, or hospital-based educator, can help you prepare for a future role in academia. Academic teaching shares many of the basic tenets of all educators; however, academic faculty must meet the triad of excellence in teaching, service to the profession and the organization, and scholarship. Completing a graduate degree in nursing education will certainly help to prepare you for the rigors of academia. There are a myriad of faculty development and scholarship programs that are offered by organizations, such as the Jonas Center for Nursing and Veterans Healthcare, Johnson and Johnson, and the Robert Wood Johnson Foundation, which help address the faculty shortage, the lack of diversity, and the related shortage of nurses.
The Institute of Medicine’s report, The Future of Nursing, also identified the need for the advanced education of all nurses and increased diversity at all levels of nursing. Academic nurse educators must possess the required clinical and educational competencies; however, there is always a need for experienced clinical nurses to fulfill the role of clinical instructor, and this is a great place to begin one’s transition.
Types of Academic Educator Roles
The role of the academic nurse educator varies based on the specific type of educational setting and program. Basic nursing programs include diploma, associate degree, and baccalaureate degree. Graduate programs include master’s degrees and doctoral degrees in a variety of specialty areas. Many programs are offered in traditional brick-and-mortar colleges and universities, but online programs have become very popular.
Academic teaching roles include adjunct, clinical instructor, lecturer, assistant professor, associate professor, and full professor. There are also a host of administrative positions for experienced educators—dean, associate dean, and director. All of these roles require related clinical experience and education.
Educational Requirements and Experience
The educational and experiential requirements for nursing faculty members are somewhat different depending on the actual role. In regards to educational level, faculty members must have a graduate degree at the master’s level to teach in an associate degree program and a doctoral degree to teach at the baccalaureate or higher level. There are exceptions to this rule, however. For example, a clinical instructor does not have to have a doctoral degree but does need the related clinical experience that is relevant to the clinical teaching role (e.g., a pediatric clinical instructor must have at least two years of experience working in a pediatric setting). Diploma and associate degree programs most often require their faculty members to have a master’s degree and related experience. Baccalaureate and graduate programs require faculty to hold a doctoral degree and related experience. Some academic institutions will hire faculty who do not hold a doctoral degree but are currently enrolled in a program. It is important to note that most academic institutions require that at least one degree be in nursing—baccalaureate or master’s.
Although it is not mandatory to have a master’s degree in nursing education, it is certainly helpful for your future role in academia. Another option is to complete a post-master’s certificate program in nursing education. This is especially helpful for nurse practitioners and clinical nurse specialists who are highly experienced clinicians but require further development in the principles of teaching, teaching and learning theories, course development, test construction, and evaluation.
A doctoral degree is required for most tenure track positions and/or when teaching in a graduate program in addition to most baccalaureate programs. Doctoral degrees include Doctor of Philosophy (PhD), Doctor of Education (EdD), Doctor of Nursing Science (DNSc), and Doctor of Nursing Practice (DNP). There are numerous other doctoral programs, but these are the most common ones for nurse educators. Academic institutions may have different requirements regarding educational and clinical experience, so be sure to do some research before deciding on which degree program to attend.
Nurse educators tend to teach in the area of their specialty, such as medical-surgical, psychiatric nursing, or pediatric nursing, but one must be versatile because you may be asked to teach new or unfamiliar content. Because health care and technology are rapidly changing, it is vital to engage in lifelong learning and development and stay abreast of the current literature.
Major Responsibilities and Key Attributes
Nurse educators have numerous responsibilities and, as such, require certain attributes and qualifications that will guide them in their transition into the world of academia. In OJIN: The Online Journal of Issues in Nursing, Penn, Wilson, and Rosseter argued that nurse educators must have the following: teaching skills; knowledge, experience, and preparation for the faculty role; curriculum and course development skills; evaluation and testing skills; and personal attributes. Additionally, nurse educators are also expected to serve as advisors and mentor students, serve on committees, and make significant scholarly contributions.
Being passionate and caring about your profession and your students is very important. As a nurse educator, you will spend a good amount of time developing various course items in addition to reading and evaluating students’ work, so writing and communication skills are vital. You will also need to clearly articulate the information you share with your students and peers, in addition to being a good listener. Time management and organization are also essential because the role of the academic nurse educator is extremely demanding.
Teaching, Service, and Scholarship
The three requirements for tenured and many non-tenured faculty members are teaching, service, and scholarship. Depending on the type of faculty appointment, there will be an expected/required percentage of each one of these. For example, in many academic settings, teaching will be the most heavily valued. However, if you are teaching at the doctoral level at a research university, then scholarship in the form of research will be equally important.
Nevertheless, the most important goal for new faculty is to become an exemplary and expert teacher. This is accomplished with experience, education, reading current literature, mentorship, evaluation (self, student, and peer), and faculty development programs. Nurse educators will eventually develop their own unique style that is influenced by personal beliefs, pedagogies, and philosophy (including the influence of their academic institution’s philosophy). Faculty development is an ongoing process and requires self-direction and motivation. It is important to develop a specific plan for how you will continue to develop your teaching skills.
Scholarship relates to learning, research, and scholarly publications. The type of required scholarly works will be dictated by your academic organization and your specific faculty appointment. Scholarship includes conducting research, peer reviewing for publications, and presenting at conferences.
Service requires one to contribute to the organization and profession without financial compensation. Typically, this includes serving on committees, serving on an editorial board, or serving as a peer reviewer. There are certainly many other ways to meet this requirement, which may also involve serving one’s community.
Rank, Tenure, and Academic Freedom
Many full-time faculty positions are tenured. Ranks include instructor, assistant professor, associate professor, and full professor. When faculty members receive an academic appointment, they are given a contract that states their rank and the number of years they have to demonstrate that they have met the required expectations of teaching, service, and scholarship to earn tenure. Tenure is one of the ways academic freedom is protected. Academic freedom pertains to a faculty member’s right to teach content, conduct research, and write or speak without censure, with the caveat that he or she demonstrates sound judgment when teaching content, especially if it is controversial. Faculty must be careful not to influence their students’ beliefs or abuse their power as educators. All faculty members should be well versed in the rights and legal, ethical, and moral responsibilities that are inherent in this role.
Ways to Transition to a Nurse Educator Role
In addition to experience and education, transitioning to the role of nurse educator requires the development of realistic goals and objectives. If you truly have the desire to teach, you should develop a specific plan with all the steps you will need to complete to meet your goal. Utilizing the nursing process will help you to develop a realistic plan. The first step is to assess your current level of knowledge, skills, education, and attributes. From there, you can begin to develop a specific individualized plan for how to accomplish each objective. Note that, if you do not have an advanced degree, you will need to enroll in a graduate program, so be sure to carefully consider which program will be best for you.
As a graduate student, you may have an opportunity to work as a teacher’s assistant, which will provide you with invaluable experience. You should seek out as many teaching experiences as you can. Consider becoming a mentor or preceptor, join the patient education committee, or develop a continuing education article. You should also consider becoming an adjunct clinical instructor in your specialty area, which is a great way to “test the waters” and eventually transition to a full-time faculty role.
Reading the current literature and attending conferences are also very helpful. You will need to network and consult with your mentor. Furthermore, developing a professional portfolio with a well-developed resume—or curriculum vitae—is crucial when applying for a faculty position.
It is also advisable to participate in mock interviews so that you will be prepared for an actual interview. It’s worth noting that the interview process at an academic setting is unique; you will most likely be interviewed by a search committee. Don’t be surprised if you are asked to demonstrate your teaching skills and share your philosophy of teaching.
Develop a Five-Year Plan
Developing a five-year plan with goals, objectives, and actions with specific dates can be very helpful when planning your transition. The goals should be realistic and achievable, and the objectives should be measurable. The actions are the steps needed to meet your objectives and accomplish your goals. Goals may be related to earning an advanced degree, obtaining a position as an adjunct, or applying for a full-time faculty role.
The plan should be evaluated on an ongoing basis and revised in accordance with your current needs. It is important to remember that plans are not set in stone and can always be revised. When you complete your first five-year plan, you will want to begin another one as you continue on your journey as a nurse educator.
Although the transition may be challenging, there are many strategies you can employ to guide you through this process. The journey from clinician to educator is filled with tremendous growth and learning.
Deborah Dolan Hunt, PhD, RN, is an associate professor of nursing at The College of New Rochelle. She is the author of The New Nurse Educator: Mastering Academe and The Nurse Professional: Leveraging Your Education for Transition into Practice.
Current literature reminds us that active learning helps promote critical thinking and problem-solving abilities. Active learning requires that students be engaged through more than listening, reading, writing, and discussion.
Research has significantly proven the opposition amid adult and child learning styles. Established on the research that adults do not learn in the same style as children, it is practical to accept that one cannot teach adults employing methods developed and planned to facilitate the learning experience of children. Malcolm Knowles, a pioneer in the field of adult learning, hypothesized some assumptions to assist teachers with teaching children and adults. These assumptions include:
The Need to Know. Adult learners need to know why they need to learn something before undertaking to learn it.
Learner Self-Concept. Adults need to be responsible for their own decisions and to be treated as capable of self-direction.
The Role of Learners’ Experience. Adult learners have a variety of life experiences that represent the richest resource for learning. These experiences are, however, imbued with bias and presupposition.
Readiness to Learn. Adults are ready to learn those things they need to know in order to cope effectively with life situations.
Orientation to Learning. Adults are motivated to learn to the extent that they perceive that it will help them perform tasks they confront in their life situations.
The reason most adults enter any learning experience is to create change. This could encompass a change in their skills, behavior, knowledge level, or even their attitudes about things. In a 2006 article published in the journal Urologic Nursing, Sally Russell suggested that, compared to school-age children, the major variances in adult learners are in the degree of enthusiasm, the extent of earlier experience, the level of engagement, and how the learning is applied. Double testing allows the adult student to be engaged in the learning process.
Students need support and validation from their peers. In any classroom, evaluation is necessary. In 2012, the National League for Nursing suggested in its fair testing guidelines that tests and other evaluative measures should be used “not only to evaluate students’ achievements, but, as importantly, to support student learning, improve teaching, and guide program improvements.” Double testing is one such teaching method in which evaluation, peer support, and validation can be instituted to support student learning.
Instructors who teach in higher education can no longer rely on lecturing as their main teaching method. In Teaching in Nursing: A Guide for Faculty, scholars Diane Billings and Judith Halstead emphasize that dependence on the use of the lecture is no longer an accepted teaching technique. Instead, faculty must integrate the use of technology so that students will be more actively involved and engaged in the learning process. Also, faculty must focus more on teaching in a learner-centered fashion, as opposed to the teacher-center approach.
Double testing has been proven to be an effective teaching method. A 2013 study published in Nursing Education Perspectives found that learning, communication, and collaboration were prevalent themes in students’ perceptions and opinions of double testing. According to the researchers, the study found that “a majority of students preferred double testing and indicated that this testing method had more advantages than disadvantages.”
Throughout nursing programs, instructors are responsible for assessing students’ abilities and assuring they are competent to practice nursing. Since one of the nursing instructor’s goals is to prepare students to be safe and competent nurses, I believe that collaborative learning, such as double testing, is an excellent strategy to assist students in being able to successfully care for patients. I have used this teaching method for more than two years with senior two-year nursing students and have found that double testing promotes group interaction, interpersonal skills, and interdependence among the nursing students—qualities needed to work with members of any health care team.
In using the double-testing method, I have also found that students are more engaged and more cooperative; they also exhibit improved critical thinking skills. For example, when double-testing scores were compared over a six-month period, students’ overall grades increased from 69% to 82%. Indeed, a systematic review conducted by The Campbell Collaboration confirms that the benefits of collaborative testing “include—but are not limited to—better critical thinking skills, better collaboration and team work among peers, reduced test anxiety, and improved test taking performance.”
In a 2011 study published in Science, Deslauriers, Schelew, and Wieman compared the amount of learning students experienced when taught—in three hours over one week—by traditional lecture and by using interactive activities based on research in cognitive psychology and physics education. The researchers found that students in the interactive class were more involved and absorbed more than twice the learning than their colleagues in the traditional class.
Twenty-first century students should be allowed some control over their learning. For many years, teacher-centered instruction has been dominant in higher education. In a traditional classroom, students become passive learners or just receivers of teachers’ information; whereas, with double testing, the students make the decision whether or not to participate. This way, students take charge of their own learning and are openly involved in the learning process.
In “Helping Students Get to Where Ideas Can Find Them,” an article published in 2009 in The New Educator, Eleanor Duckworth asserts that teacher-centered learning actually hinders students’ learning. In contrast, double testing is a learner-centered teaching method, which focuses on how students learn instead of how teachers teach.
I believe that double testing is a worthy teaching method that instructors can use in the classroom to enhance student-student and student-teacher interactions. Most educators understand that learners have different preferences and styles of learning and believe that it is essential to use teaching methods and approaches that will satisfy the variety of learning styles in the learning event.
Annie M. Clavon, ARNP, PhD, MS, CCRC, is an associate nursing professor at Keiser University in Ft. Lauderdale, Florida.
Racially and ethnically diverse populations have grown in the US. The US Census Bureau finds that approximately 37% of the population is made up of minority groups. Nurses currently make up the largest group of health care professionals in the US, and the need for culturally diverse nurses in the workplace has been identified by many nursing leaders. The demand for culturally competent care has brought attention to the need for culturally diverse nurses. Several studies have identified that failure to provide culturally competent care can influence health outcomes. A 2009 study published in Health Affairs found that increasing minority representation in the health care workforce could have a positive effect on curbing the health care disparities found in minority populations.
The need for culturally competent health care highlights the need for a diverse nursing workforce, particularly since patients tend to migrate towards providers that share their ethnic background. Minority nurses and possibly advanced practice nurses are in a position to help these often underserved minority communities receive care that will increase their likelihood of compliance with medical treatment and increased health literacy.
Additionally, implementation of the Affordable Care Act will allow for the expansion of health insurance to historically underserved populations. This expansion will require an increase in the number of health care professionals available to care for these populations.
Of the almost 3 million registered nurses in the US, approximately 133,000 are black and 55,000 are Hispanic. A 2013 study published in Journal of Transcultural Nursing reveals that minority students account for about 27% of the students in undergraduate schools of nursing. The low number of minority students represented in the undergraduate nursing school enrollment numbers highlights the difficulty noted by graduate schools when it comes to attracting and enrolling minority registered nurses.
Federal initiatives like the Promoting Postbaccalaureate Opportunities for Hispanic Americans program authorized under Title V of the Higher Education Act of 1965 are designed to expand postbaccalaureate opportunities and academic offerings for universities that are educating the majority of postsecondary Hispanic students. According to a 2010 brief published by Excelencia in Education, there were 176 emerging Hispanic-Serving Institutions (HSIs) in 2007. Federal law requires that in order to receive a designation as a HSI, an institution must have at least 25% Hispanic undergraduate enrollment. Emerging HSIs are those with Hispanic enrollment within the range of 12% to 24% and have the potential to become HSIs over the next few years. The HSI designation allows an institution to qualify for grants and other modes of funding. A 2010 study published in Journal of Latinos and Education found that, behind funding, the most important issue facing the presidents of HSIs was the lack of academic preparedness of the students.
Challenges are faced by Hispanic nurses desiring to pursue advanced nursing degrees. Like undergraduate enrollment, the number of registered nurses with baccalaureate degrees applying for advanced practice nursing tracts is low. There are four HSI institutions that offer nurse anesthesia in these fine programs: University of Miami, Kaiser Permanente / California State University, Inter-American University of Puerto Rico, and the University of Puerto Rico. A relatively large Hispanic applicant cohort of prospective students submit to these diverse nurse anesthesia programs along with other urban located institutions within the US. A barrier that some underrepresented students encounter is the lack of academic preparedness and/or lackluster graduate exam scores. This lack of academic preparedness equals fewer applicants who are adequately prepared for undergraduate and graduate education. In the event that a student is successful in an undergraduate program, lack of preparedness could lead to the preparation of a graduate application packet that is not representative of the candidate’s true potential.
Optimization of the nurse anesthesia program application packet can mean the difference between acceptance and rejection. The graduate application for nurse anesthesia school normally contains many components. The application is the first glimpse of the candidate presented to the admission committee. One crucial component of the process is the essay. The essay should contain information that the candidate wants to express describing his or her participation in leadership and extracurricular activities. Admission committee members take note of well-rounded candidates. Candidates should include evidence of involvement in professional nursing organizations and hospital committees. These types of activities highlight the candidate’s desire for professional development. The essay should be edited for grammar, spelling, and content before the packet is submitted to ensure that the candidate appreciates attention to detail.
The construction of a comprehensive application will most likely yield an interview, but the interview process can be intimidating. Most admission committees attempt to evaluate the student’s preparedness for the rigors of the program. The types of questions revolve around principles of physiology, pathophysiology, and pharmacology. Candidates who recognize their deficiency in interviewing should seek out opportunities to practice these techniques. Career centers may offer opportunities to hone interviewing skills.
Prospective students tend to focus on securing a seat in a nurse anesthesia program, but it is unclear how many actually consider the rigorous nature of the program. The amount of preparation that goes into the admission to a nurse anesthesia program is only minimized by the challenges of the didactic and clinical experiences for a new student. These challenges should be considered in conjunction with other stressors that can include financial obligations, reduction of income, and family responsibilities.
How to Strengthen your Application and Secure an Interview
According to the American Association of Nurse Anesthetists (AANA)’s 2012 demographics of nurse anesthetists in the United States and Puerto Rico, as an aggregate number, there is less than 10% of underrepresented minority nurse anesthetists from the 44,000 advanced practice nurses practicing in hospitals, surgery and endoscopy centers, and dental and pain management offices. Less than 3%, 3.2%, and 0.5% are from Hispanic, African American, and American Indian groups, respectively. To learn more about becoming a certified registered nurse anesthetist (CRNA), visit www.aana.com/ceandeducation/becomeacrna. Here, students will find information about the requirements of becoming a CRNA as well as a list of accredited nurse anesthesia programs, frequently asked questions, and a list of related published articles. It is imperative that prospective applicants into a nurse anesthesia program peruse not only the nurse anesthesia program of interest website, but also our national nurse anesthesia association website.
It is vitally important that underrepresented minority nurses learn more about the history of nurse anesthesia and national implications of advocacy. The book Watchful Care by Marianne Bankert is a great resource. It will expand your knowledge about nurse anesthetists and prepare you adequately for the interview, if the admission committee members ask any questions about this well-read topic. The top candidates definitely shine during the interview if they have read this material.
Another way to strengthen your application is to include your shadowing experience with a CRNA in the operating room. You should contact the CRNA and ask to meet him or her in the operating room on an agreed time. Be prepared to witness the CRNA prepare the room by checking the anesthesia machine and related equipment as well as prepare medications for the planned anesthetic prior to a patient’s arrival in the operating room. In addition, you will witness the CRNA interview the patient extensively about his or her medical and surgical history, review and secure the anesthesia consent, and perform an oral exam to assess a Mallampati score (I – IV) to anticipate an easy or difficult intubation prior to entering the operating room. During the shadowing experience, ask plenty of questions about what type of anesthetic is being administered (such as general, regional, or sedation), fluid management, positioning considerations, and more.
Along with learning the history of nurse anesthesia, as a critical care nurse with a baccalaureate degree, you should study and schedule the critical care registered nurse (CCRN) exam offered by the American Academy of Critical Care Nurses (AACN). Information regarding this exam can be found on the AACN website (www.aacn.org). This test demonstrates aptitude in critical care nursing and professional commitment towards excellence. A significant number of nurse anesthesia programs require applicants to earn critical care experience and sit for and pass the CCRN exam prior to actual submission of the essay for a nurse anesthesia program.
Another viable option for underrepresented minority nurses to improve the application process, handle the stressful interview, comply with the rigor of a nurse anesthesia program, excel for clinical preparedness, and learn about doctoral programs in nurse anesthesia programs is to register and attend Diversity CRNA Information Sessions & Airway Simulation Labs scheduled in 2014. This event, sponsored by the Diversity in Nurse Anesthesia Program (www.diversitycrna.org), offers an opportunity to those interested in nurse anesthesia education to fully engage oneself and learn comprehensive information about the process, network, and participate in a hands-on simulation experience in the lab. You will also have the opportunity and access to meet four nurse anesthesia program directors, AANA senior leadership, minority CRNAs, and nurse anesthesia students from across the country. As a result, you will have the ability to include details about your experience in your eventual essay and articulate it during your interview.
An additional application requirement of some anesthesia programs is the Graduate Record Examination (GRE). It is incumbent of any prospective applicant to visit the GRE website (http://www.ets.org/gre) to learn about the comprehensive information about the scores and the actual make-up of the exam (verbal reasoning, quantitative reasoning, and analytical writing).
So, now it is up to you. Will you peruse through the suggested websites to broaden your knowledge base about proper preparation for entry into nurse anesthesia? Do you want to be a competitive applicant for a nurse anesthesia program? Do you want to be academically and clinically prepared for such a program? If you answered yes to these questions, be proactive in your educational goals to advance your professional development in a nurse anesthesia program. You can do it!
Wallena Gould, CRNA, EdD, is the founder and chair of the Diversity in Nurse Anesthesia Mentorship Program (www.diversitycrna.org) and chief nurse anesthetist at Mainline Endoscopy Centers.
Martina Steed is a CRNA and Associate professor and Assistant director in the Department of Nurse Anesthesia at Webster University in St Louis, Missouri. She is also a small business owner and PhD candidate in the College of Health Sciences at Walden University.
The International Dyslexia Association describes dyslexia as “a specific learning disability that is neurological in origin. It is characterized by difficulties with accurate and/or fluent word recognition and by poor spelling and decoding abilities.” Dyslexia is a condition that does not change in one’s lifetime.
I knew I had dyslexia when I applied to nursing school in 2007. About a decade prior, I received the diagnosis of dyslexia during my unsuccessful attempt to get into graduate school. At age 43, with a daughter in middle school and a supportive husband, I was willing to try a career change again. I succeeded in my prerequisites courses, receiving A’s in Chemistry and Microbiology and a B in Anatomy and Physiology. I thought somehow maybe I “outgrew” being dyslexic. I really knew nothing about what dyslexia was. I knew learning to read was really hard and I got pulled out of reading groups in fourth grade, but I still don’t know very much about it. I knew I did not want reading differently to stop me. I still have so much to learn.
My first try at nursing school was in an accelerated nursing program. The documentation stating my dyslexia diagnosis was more than 10 years old. I attended a community college to complete my prerequisites. The community college was able to accept the documents I had and explained that a university would require updated documentation confirming the condition. To get retested and get current documents would cost approximately $600 to $1,000—an added burden to the cost of tuition and books.
Accommodations for my dyslexia during the accelerated program could not be available because of the outdated status of my documents. Nevertheless, I felt elated because my grades from my prerequisites were high. Fifteen weeks into the accelerated program, I “washed out” and voluntarily withdrew. But, I had a plan. I got retested and got the updated documentation. I also became a Certified Nursing Assistant (CNA). In seven months, I got the call inviting me to join the traditional Bachelor of Science in Nursing (BSN) program. I literally cried with joy. I had another chance.
The tests to assess learning disabilities are not difficult. There were four one-hour sessions, including tests—some written, some verbal, and one involving making shapes with blocks. One test measured my reading speed. I was instructed when to start and, at different times, I was asked to point to where in the article I had read to in the given time. Once the allotted time was completed, I was asked a series of questions to test my comprehension.
Soon after completion of the testing, I enrolled in CNA training. Becoming a CNA significantly contributed to my understanding of many principles I had learned in lecture on the fundamentals of patient care. As a CNA, I was able to learn at the bedside while developing relationships with patients and practicing the skills from both lab and clinicals. Nineteen days after finishing CNA training, I was employed at the location where we completed our clinicals. Having a job as a CNA provided me with the opportunity to make real the theory I had learned in class. The opportunity to work next to real nurses let me watch the lessons you cannot learn through books. My confidence grew as my dedication to complete the BSN degree cemented. Once I returned to the classroom as a student nurse, I was wholly committed to completing the program.
Being back in class gave me the opportunity to fulfill my dream of being a nurse while receiving a variety of accommodations for dyslexia:
Transparencies: Color transparencies over a printed page, which function like sunglasses on a sunny day. The distortion is minimized. This simple fix considerably reduces the strain from reading.
Kerzweil Text-to-Speech Reader: A computer program that changes text into audio. All the computers on campus can utilize Kerzweil, so I bring earphones in order to listen to my tests or texts.
Testing Center: All of my test taking is completed in the test center. An appointment with the test center is scheduled four days prior to each exam. To limit distractions and noise, I test in a room alone.
Time-and-a-Half: My test appointment time is 1.5 times the allotted time in the classroom. So, I go to the testing center early, usually 7:30 a.m. for an 8:00 a.m. test. Rarely do I need the extra time, but the benefit is not having to worry that I might run out of time near the end of the exam. This reassurance really makes a difference, especially when I go back to recheck answers.
There are many parts when I take an exam—it resembles conducting an orchestra. All of the material requires management to maximize my comprehension of the technical questions being asked. There are inputs from four tests simultaneously, so I can receive the information efficiently. There is one test in front of me that I manually mark up, which is covered with a color transparency. This paper test is returned to my instructor. It is a back-up in case there is a computer malfunction.
There are also two tests on the computer. One of the tests on the computer is in the Kerzweil program. This program reads the test to me so I can hear it in my earphones. Kerzweil highlights each sentence in yellow as it is being spoken and each word in that sentence is highlighted in pink.
The second version of the test on the computer is the one that I must complete and submit to the instructor for grading. The final version of the test is the audio in the Kerzweil program. Most of my classmates don’t notice that I am out of class during tests. Usually, when I explain I have a learning disability, the first reaction I get is disbelief since I always participate in class discussions.
It is best for me to prepare for lecture prior to class time. I ask many questions as the material comes up in lecture. To classmates, it might appear that I am really enthusiastic—which I am—but I don’t really have many other options. If I can’t understand a concept from the book, it is easiest to ask during lecture. I am always the most surprised when I get high grades on exams.
During the summer of 2010 between my junior and senior years, I enjoyed participating in an externship. This consisted of fifteen 12-hour shifts, during which I followed a preceptor on the telemetry floor at a major medical center. This externship provided many opportunities for verbal questions and answers—my preferred learning style. My preceptor was incredible. She was open to learn about my learning needs, and we discussed possible precautions to take in order to maximize my performance on the floor.
According to my preceptor, there was no evidence of disability in my performance. I did use a color transparency when there was a lot of material to read and comprehend, but that was the only accommodation I used on the floor. The transparency was also a folder that held materials that I needed, so it blended in discreetly.
Despite research articles in the medical literature raising skepticism about nurses and nursing students with dyslexia, most articles call for the need for more research. There are laws that prohibit discrimination against individuals with disabilities, but application of these laws to nursing students and new nurses with dyslexia is an area that appears vacant. I have not found another group of student nurses that is directly being targeted in this way.
The United Kingdom leads the way in accommodating the needs of dyslexic students. England has a complete, published protocol that details how to best maximize the learning abilities of dyslexic student nurses while ensuring the safety for all. The idea of whether dyslexic student nurses should be allowed to practice in the United Kingdom is never questioned.
Unable to locate a voice from the perspective of dyslexic student nurses, I founded Nursing Students with Dyslexia (NSwD) on www.NursesLounge.com, which is a social networking site geared specifically to nurses and student nurses. Students are able to join NSwD directly at http://community.nurseslounge.com/join/nswd. This page includes research available on assisting student nurses with dyslexia, along with resources and scholarship opportunities.
Someday, I hope to develop a scholarship that encourages student nurses with dyslexia to network together. Maybe by sharing our stories of success we can offer greater insights into the challenges that dyslexic student nurses must overcome. Nursing education is expanding its understanding of how to provide the most successful learning experience for students, including student nurses with dyslexia. I am proud and honored to be a voice as a student nurse who is not letting a disability define or limit me.
